Laura D. Byham-Gray, PhD, RD is a Professor (tenured) of Nutritional Sciences at Rutgers University- Biomedical and Health Sciences (RBHS) who has focused her career on conducting clinical nutrition research. She is applying for this training grant in order to pursue her career goals of developing new skills in Patient- Centered Outcomes Research (PCOR), inclusive of integrating a stakeholder engagement portion to future CER studies. Career Development Plan: Dr. Byham-Gray's training will include two years of guided mentorship to augment her research training and skills, and to acquire new knowledge and competence in CER/PCOR. Mentors [Drs. Stephen Crystal from the Rutgers Institute for Health, Health Care Policy and Aging Research (IHHCPAR) and Glenn Chertow from the Dept. of Nephrology at Stanford University (SU)] with collaboration from Dr. Donald Hoover, Professor of Statistics from IHHCPAR and her Career Advisory Committee (Drs. Brian Strom, Chancellor of the RBHS, Riva Touger-Decker, Chair of the Dept. of Nutritional Sciences, Peter Gillies, Professor in Nutritional Sciences at the Rutgers Institute for Food, Nutrition, and Health, Francesca Tentori, Senior Research Scientist at Arbor Research Collaborative for Health, Charlotte Thomas-Harkins, Associate Professor at the Rutgers School of Nursing, and an incident dialysis patient from the National Kidney Foundation) will oversee Dr. Byham-Gray's career trajectory. Didactic education in CER/PCOR is planned through Rutgers University specifically in the areas of 1) quantitative methods as it relates to handling administrative datasets and 2) qualitative research for stakeholder and patient engagement. Experiential training will be completed in tangent with these courses. Institutional Environment: RBHS (formerly the University of Medicine and Dentistry of New Jersey) has been an active leader in clinical research, conducting over 3,000 clinical studies. RBHS' emphasis is on outcomes research, epidemiology, and population science. Dr. Byham-Gray will have protected time within her department to obtain such mentorship as well as to conduct the proposed research project. Description of Project: Dr. Byham-Gray will apply PCOR skills to an AHRQ priority population of patients diagnosed with chronic kidney disease (CKD) maintained on dialysis, who require specialized medical and nutritional care. She will use existing data from the Comprehensive Dialysis Study to examine the modifiable and unmodifiable etiological factors for protein-energy wasting (PEW) risk among incident dialysis patients and to determine the effect of PEW on patient-centered outcomes. The Deliberative Panels of patients/stakeholders will share perceptions and ideas on the current and future research, assuring that the proposed project as well as further work focuses on outcomes that matter the most to patients/caregivers. Findings will inform the development of clinical decision-making tools for lowering overall PEW risk.